Do I have symmastia? Are my breasts botched? (Photo)

Hello,

Thank you for the question.

Based on your photos, you do appear to have symmastia which can happen when both implants have been placed too close to each other and the tissue that separates them is stretched or merged. The skin lifts off the underlying sternum (breastbone). This causes a patient's breast to connect more in the midline than normally.

In order to correct symmastia, revision surgery can be performed using capsulorrhaphy technique with or without mesh reinforcement.

I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Surgeries in order to discuss your goals and concerns for the best cosmetic results.
I hope this helps.

Best regards,

Dr. Irena Karanetz
Breast Fellowship-Trained
Board Certified Plastic Surgeon

Thanks for your question! It does appear as though you do have symmastia. While its a difficult cat to get back in the bag, it's not impossible. I would suggest an in-person consultation for the best recommendations. Good luck!

Hi from Istanbul, you do appear to have symmastia, sorry you're experiencing this problem. It's a complication that can occur after breast implant procedures (likely also influenced by the patient's anatomy) so it's more of a surgical complication rather than a botched result. But it can be addressed by creating a new breast implant pocket. I recommend getting a revision surgery. Best of luck to you!

When implants are placed, the position of the nipple must be taken into account, such that the nipple is at the apex of the breast mound. In your case, the breast footprint has been violated, placing the implants too close to midline on the chest wall. This is fixable. The implants must be removed, the pocket closed down with sutures in the midline such that the breast is lateral to the sternum(chest bone). Smaller implants centered under the areolas would then be placed to restore a good aesthetic result.

You are correct, in that your nipples were set far apart to begin with. However, when the implants were placed, they should’ve been placed so that the nipple is centered nearly at the midpoint of the implant on both a horizontal plane as well as a vertical plane. You may not have the cleavage that you wanted, but you would not have ended up with your nipples appearing to be sitting very far out on your chest. A revision should be possible with this. Speak at length with your plastic surgeon. Best wishes.

In order to correct your symmastia deformity a separation of the breast implant pockets needs to be created using artificial mesh or patient own tissue. This will also require replacement of implants and possibly lateral expansion of implant envelope by means of capsulotomy. Smaller, narrow base implant should be considered. In person consultation with a board certified plastic surgeon with experience in this problem is recommended. Good luck.

Dear Dazzling197848,
symmastia is a rare breast condition that occurs when soft web-like breast tissue pulls breast implants towards each other, until the breasts meet uncomfortably at the center of the chest near the sternum (the body’s midline point). Given this abnormal union, symmastia is known by many other names, including breadloafing, kissing breast implants, and the uniboob.Unfortunately, this condition causes the surrounding skin and pectoral muscles to literally lift off the breast bone as the implants are pulled together. This consequently causes pain and discomfort, as well as obvious distortion of the breasts, which can only be disguised with clothing that does not show cleavage.You should consult with a board certified plastic surgeon for proper assessment. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

From the photos it appears you would benefit from a revision. The nipple position and shape can be improved. Different implants may be a better fit for you. See a board certified plastic surgeon to discuss your concerns and learn more.

If the fullness bothers you, then go down in size, maybe to 200 cc's, and go with a higher profile. You are not "botched" but do have some challenging anatomy issues.

Breast augmentation outcomes are usually based on three variables.
The first is patient candidacy. The second is implant selection and the third is the surgeons skill in the ability to put the implant in the correct anatomic location.
In your case your candidacy for the procedure was less than ideal to start with.
Your breast are placed wide on your chest wall with significant divergence. The divergence will be amplified by making the breast larger.
This is also true regarding the breast position on the chest wall.
Most people have a left breast that sits higher on the chest wall than the right side.
This is true for you as well.
There is a significant curvature of your midline.
If you follow your midline from your bellybutton up to your neck, you’ll see that it has a significant curve to it.
All of these variables contribute to your candidacy for the procedure and candidacy has a big impact on what the outcome looks like.
My personal preference is to put the implant centered under each breast even if the breast sit wide apart and are uneven. Other surgeons do it differently.
When the breasts sit really wide on the chest wall that often creates a big gap between the implants if the implants are centered the each breast.
In your case, your surgeon put the implants in position of what is ideal of where your breast’s should be which is not where they are located.
Had your surgeon centered the breast on each nipple then your breast implants would sit wide apart.
Either way the outcome is going to look a bit odd.
I generally lean towards centering the implant on each breast even if that makes the implant position asymmetrical.
a lot of plastic surgeons do what your surgeon did which is to put the implants in a more ideal position, even if your breast are not positioned ideally.
I don’t think there is a right or wrong.
Both options come with their drawbacks.
Having the implants sit far apart will get patients unhappy just as much.
Whenever patients are less than ideal candidates for breast augmentation surgery, it’s really important to explain the variables that limits their candidacy, and what this means in regards to outcome.
In a perfect world, the plastic surgeon would show you before and after pictures of other patients who also had highly divergent nipples with breast that were asymmetrically placed wide on their chest wall. By explaining each individual patients candidacy for the procedure patients can have a better understanding of what the result is going to look like.
This is part of setting expectations correctly.
When a patient is less than ideal in regards to candidacy, this should be pointed out during the consultation, so the patient knows what to expect.
I’m not sure if your surgeon talked about the divergence or the position of your breast on your chest while during your consultation?
Any of these variables that lower a patient’s candidacy for the procedure are usually amplified by making the breast bigger.
The divergence is not so noticeable when the breasts are small but The divergence becomes put on display with augmentation.
I don’t think you have true synmastia.
I do not believe the implant pockets are connected.
Revision surgery with opening the pockets in the more lateral direction will cause your implants to sit further from the midline and more centered to the nipple.
Perhaps your surgeon could’ve been a little careful to not push for the cleavage look considering your baseline breast position.
I think your implant size is appropriate and I don’t see a strong need to change implants.
Smaller implants will draw less attention to the divergence and maybe an advantage if you want to decrease the cleavage look.
I think in your case, your candidacy for the procedure is the biggest issue and I think to some degree your surgeon could’ve placed the implants with a little more focused to on being centered on each breast rather than putting the implants in a more ideal position.
When the breast are not in an ideal position to start with, it’s always a bit of a challenge. The surgeon cannot move the breast on the chest wall.
If your outcome bothers you enough to have revision surgery, then consider consulting with other providers or have another follow up with your surgeon.
Whether repositioning the implants is a worthy pursuit, depends on what you’re trying to achieve.
Regardless, it’s going to be “borrow from Peter to pay Paul”.
Putting the implants laterally has its own drawbacks.
Sometimes explaining these concepts is better done in person.
Best,
Mats Hagstrom MD